Physician Advisor; Psychiatrist

Full Time 801 Market Street, Philadelphia, PA, US

The Physician Advisor provides strategic oversight of medical necessity determinations for behavioral health services, ensuring alignment with clinical standards and organizational objectives. This role is accountable for conducting medical necessity and peer reviews, directing the activities of the crisis team, and fostering collaboration with clinical providers to promote high-quality, effective mental health care for CBH Members.

• Review cases from multiple sites and levels of care for medical necessity.
• Peer review cases for disputed levels of care.
• Perform medical reviews
• Make denial decisions based on medical necessity
• Participate in clinical and administrative meetings.
• Interact with providers on clinical and administrative matters.
• Serve as clinical leadership resource and consultant to Clinical Care Managers, offering guidance on complex cases and best practices.

• MD/DO from Accredited Medical School

• Current Board certification in Psychiatry and/or Child and Adolescent Psychiatry by the American Board of Psychiatry and Neurology;
  Current and Active State of Pennsylvania Medical License
• Minimum of 5 years of clinical psychiatry experience including significant and specific experience with inpatient care and substance abuse treatment

• Ability to provide clinical oversight on a wide array of operational activities.
• Strategic planning
• Excellent written and verbal communication skills
• Familiarity with medical assistance regulations and managed care principles and practices
• Knowledge of Managed Care Organization operations and principles.
• Demonstrated leadership ability.

Community Behavioral Health (CBH) will hold each employee accountable for the following expectations, which align with our mission, vision, and corporate code of conduct.

• Perform key responsibilities as detailed in this job description in a dependable, responsible, and positive manner, consistent with all state and federal guidelines.
• Serve as a role model by exemplifying professional behavior, language, skills, and attire to promptly and accurately serve the needs of stakeholders, members, and their families.
• Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost-effective manner.
• Promote and manage diversity and acceptance within CBH and with all members and stakeholders by honoring and respecting their individuality, dignity and rights.
• Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs.
• Actively participate in required meetings and complete all mandatory trainings.
• Maintain high levels of advocacy and member confidentiality to ensure the success of CBH and our mission.
• Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud, waste or abuse.

• Teamwork and Collaboration
  :
  Build and sustain relationships with co-workers and stakeholders and support efforts and deliverables. Encourage unity and help remove barriers to productivity and success.
• Respect
  :
  Treat each other and our members and stakeholders with respect and sensitivity, recognizing the importance of diversity.
• Member Centric
  :
  Focus on the needs of our members by providing value-added services, promoting strong relationships and going beyond basic expectations to achieve the best possible outcomes.
• Honesty and Integrity
  :
  Be open and honest in all we do. Always maintain the highest level of integrity.
• Commitment to Service Excellence
  :
  Challenge ourselves to be forward-thinking and committed to providing total member and stakeholder satisfaction, first-in-class service and high quality, innovative programs.
• Compassion and Empathy:Demonstrate a deep appreciation for another’s situation and point of view. Pay attention to emotional cues, listen effectively and show an exceptional care about each person’s perspectives and circumstances.
• Problem Solving
  :
  Build and implement logical solutions to resolving challenges/issues by using individual knowledge and experience while taking resources, constraints and CBH values into consideration.
• Initiative and Self-Directed
  :
  Proactively manage time and resources in a way that ensures that all work is done in the most efficient manner while identifying and…